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Organization
INNOVATIVE OUTPATIENT MEDICAL SYSTEMS
Active
Organization
INNOVATIVE OUTPATIENT MEDICAL SYSTEMS
Active
Other names
Innovative Care Therapy Center
Organization subpart
No
Provider details
NPI number
Authorized official
PHILIP DEJONG (VICE PRESIDENT)
(708) 532-1337
Entity
Organization
Contact information
Practice address
18425 WEST CREEK DRIVE, SUITE G, TINLEY PARK, IL 60477-6767
(708) 532-1337
(708) 532-1899
Mailing address
18425 WEST CREEK DRIVE, SUITE G, TINLEY PARK, IL 60477-6767
(708) 532-1337
(708) 532-1899
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9932192
BCBS
IL
Enumeration date
10/02/2006
Last updated
08/22/2020
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